=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477306082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IPSUM DIAGNOSTICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2024
-----------------------------------------------------
Last Update Date | 02/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2550 GRAY FALLS DR STE 150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77077-6687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-915-2299
-----------------------------------------------------
Fax | 800-819-0767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8607 ROBERTS DR STE 250
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30350-2237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-915-2299
-----------------------------------------------------
Fax | 800-819-0767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | FRANCIS JUSTO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 678-915-2299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------